Mental Health Service Use Among Older African Americans: The National Survey of American Life

Neighbors, Harold W.; Woodward, Amanda Toler; Bullard, Kai McKeever; Ford, Briggett C.; Taylor, Robert Joseph; Jackson, James S.

doi:10.1097/jgp.0b013e318187ddd3

“…The covariates of service use were not surprising, again extending prior studies and consistent with the NEM (10), with key demographic (age), need (major depressive episode diagnosis), attitudes (intention), prior experience (antidepressant use), and social context (advice) as important factors (19, 49–51). Stigma was not associated with service use, which could be due to its measurement, statistical power, the possibility that stigma was not as salient for this sample as it would be for a more severely depressed sample (25), or the possibility that stigma is not as significant a barrier as previously thought (52).…”

Section: Discussionsupporting

confidence: 76%

Six-Month Longitudinal Patterns of Mental Health Treatment Utilization by Older Adults With Depressive Symptoms

Gum

¹

,

Iser²,

et al. 2011

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OBJECTIVE For community-dwelling older adults with depressive symptoms, aims were to: describe behavioral health service utilization patterns over a six-month period; and identify factors associated with service use, guided by a multidimensional, comprehensive theoretical model emphasizing the dynamic nature of service use patterns over time and social context. METHODS 144 participants with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes included use of antidepressants or counseling at each follow-up. Covariates included individual (demographic, need, prior treatment experience, intentions) and social context (stigma, advice) variables. RESULTS Approximately half of participants received no formal service (antidepressant or counseling; n = 70, 48%). Service use or non-use did not change for most participants. More participants with severe symptoms received antidepressants (25–37%) than those with milder symptoms (10–14%), although more of the milder cases started (62% vs. 49%) and stopped antidepressants (77% vs. 26%) at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, service use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new service at baseline, and receipt of advice to use services over follow-up. CONCLUSIONS Over a six-month period, the majority of older adults with depressive symptoms in this study continued use or non-use of mental health services. Demographic, need, attitudinal and social variables were related to service use over time. Addressing intentions and providing advice may facilitate uptake of services.

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“…The covariates of service use were not surprising, again extending prior studies and consistent with the NEM (10), with key demographic (age), need (major depressive episode diagnosis), attitudes (intention), prior experience (antidepressant use), and social context (advice) as important factors (19, 49–51). Stigma was not associated with service use, which could be due to its measurement, statistical power, the possibility that stigma was not as salient for this sample as it would be for a more severely depressed sample (25), or the possibility that stigma is not as significant a barrier as previously thought (52).…”

Section: Discussionsupporting

confidence: 76%

Six-Month Longitudinal Patterns of Mental Health Treatment Utilization by Older Adults With Depressive Symptoms

Gum¹,

Iser²,

King‐Kallimanis³

et al. 2011

Psychiatric Services

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OBJECTIVE For community-dwelling older adults with depressive symptoms, aims were to: describe behavioral health service utilization patterns over a six-month period; and identify factors associated with service use, guided by a multidimensional, comprehensive theoretical model emphasizing the dynamic nature of service use patterns over time and social context. METHODS 144 participants with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes included use of antidepressants or counseling at each follow-up. Covariates included individual (demographic, need, prior treatment experience, intentions) and social context (stigma, advice) variables. RESULTS Approximately half of participants received no formal service (antidepressant or counseling; n = 70, 48%). Service use or non-use did not change for most participants. More participants with severe symptoms received antidepressants (25–37%) than those with milder symptoms (10–14%), although more of the milder cases started (62% vs. 49%) and stopped antidepressants (77% vs. 26%) at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, service use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new service at baseline, and receipt of advice to use services over follow-up. CONCLUSIONS Over a six-month period, the majority of older adults with depressive symptoms in this study continued use or non-use of mental health services. Demographic, need, attitudinal and social variables were related to service use over time. Addressing intentions and providing advice may facilitate uptake of services.

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“…Approximately two thirds of the suicide attempters in our study report seeking treatment for their emotional problems in the general medical sector, which is common among the elderly that engage in suicidal behavior (Cohen et al, 2008). In fact, Neighbors and colleagues found that older Black Americans tend to seek mental health care in the general medical sector more than the mental health sector (Neighbors et al, 2008).…”

mentioning

confidence: 65%

Prevalence of suicide ideation and attempts among Black Americans in later life

Joe

¹

,

Ford

²

,

Taylor

³

et al. 2013

Transcult Psychiatry

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This article provides the first national estimates of the prevalence and correlates of nonfatal suicidal behavior among older Black Americans. There is a lack of national data on suicide ideation and attempts across ethnic classifications of Blacks in a nationally representative sample. Data are a subsample from the National Survey of American Life (NSAL), a national U.S. adult household probability sample of 5,191 Black Americans. The WHO Composite International Diagnostic Interview (CIDI) was used to assess older Blacks for nonfatal suicidal behavior and 14 DSM-IV disorders. Bivariate and multivariate logistic regression analyses were employed to delineate patterns and correlates of nonfatal suicidal behavior. The estimated lifetime prevalence of suicidal ideation and attempts among older Blacks in the United States was 6.1% and 2.1%, respectively. On an average it took 2.5 and 5.7 years respectively to go from ideation to attempts or from planning to attempts. Surprisingly, among older Black adults, men reported attempting suicide and seriously consider taking their own lives more than women. Older Blacks at higher risk for suicide attempts were middle aged, had poorer health, were anxious, and had multiple DSM-IV disorders. The results also show that approximately 1 in 4 attempters and 2 in 5 ideators have never sought treatment for their emotional or psychological problems. Preventative care, particularly screening in primary care settings, should consider these findings when treating older Black Americans for psychiatric-related risk.

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Mental Health Service Use Among Older African Americans: The National Survey of American Life

Cited by 60 publications

References 30 publications

Six-Month Longitudinal Patterns of Mental Health Treatment Utilization by Older Adults With Depressive Symptoms

Six-Month Longitudinal Patterns of Mental Health Treatment Utilization by Older Adults With Depressive Symptoms

Six-Month Longitudinal Patterns of Mental Health Treatment Utilization by Older Adults With Depressive Symptoms

Prevalence of suicide ideation and attempts among Black Americans in later life

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